Literature Collection

Increases in stimulant drug use (such as methamphetamine) and related deaths creates an imperative for community settings to adopt evidence-based practices to help people who use stimulants. Contingency management (CM) is a behavioral intervention with decades of research demonstrating efficacy for the treatment of stimulant use disorder, but real-world adoption has been slow, due to well-known implementation barriers, including difficulty funding reinforcers, and stigma. This paper describes the training and technical assistance (TTA) efforts and lessons learned for two state-wide stimulant-focused CM implementation projects in the Northwestern United States (Montana and Washington). A total of 154 providers from 35 community-based service sites received didactic training in CM beginning in 2021. Seventeen of these sites, ten of eleven in Montana (90.9%) and seven of 24 in Washington (29.2%), went on to implement contingency management programs adherent to their state's established CM protocol and received ongoing TTA in the form of implementation coaching calls. These findings illustrate that site-specific barriers such as logistical fit precluded implementation in more than 50% of the trained sites; however, strategies for site-specific tailoring within the required protocol aided implementation, resulting in successful CM program launch in a diverse cross-section of service sites across the states. The lessons learned add to the body of literature describing CM implementation barriers and solutions.

This column describes Project ECHO (Extension for Community Healthcare Outcomes), a teleconsultation, tele-education, telementoring model for enhancing primary care treatment of underserved patients with complex medical conditions. Numerous centers have adapted ECHO to support primary care treatment of behavioral health disorders. Preliminary evidence for behavioral health ECHO programs suggests positive impacts on providers, treatment planning, and emergency department costs. ECHO has the potential to improve access to effective and cost-effective behavioral health care by virtually integrating behavioral health knowledge and support in sites where specialty providers are not available. Patient-level outcomes research is critical.

: Health care teams are constructive and efficient ways to approach, assess, coordinate, plan, and facilitate the client-centric and population-based care. Some iteration of team is in place across most practice settings, comprising different professionals and specialists, from multidisciplinary, interdisciplinary, and transdisciplinary to the most recent interprofessional model. This 2-part article series sets the tone for how interprofessional team-based care (IPTBC) empowers the care process. Part 1 focused on the history and fundamental concepts of interprofessional models, with outcomes to promote the value proposition for IPTBC implementation.This Part 2 article focuses on the identification of seminal group development and team processes. An original model, the Interprofessional Team Activation Cycle (ITAC), is presented, as well as defined tactics for professional case managers to promote successful implementation of IPTBC in their organizations. PURPOSE/OBJECTIVES: This article: PRIMARY PRACTICE SETTING(S):: Applicable to all health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: Shifts in reimbursement models, organizational cultures, and client populations have yielded emphasis on the swift IPTBC implementation. In addition, the recognition of team development as a fluid process endemic to achieve client-centric outcomes and organizational return on investment mandates a keen eye to the phases of a team implementation, especially those that are interprofessional in scope. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting yet not always implemented properly or successfully. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. Models focused on group development serve to support how health and behavioral health organizations consider and implement interprofessional teams.

Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.